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1. (a) Is there a PTIS-EHD contractor's questionnaire on Zile or enclosed? YES NO <br /> (b) Is the current ceriificate of worker's compensation Insurance on file? YES NO <br /> (c) Does the contractor possess a "Ilm"rdous Substance Removal Certification"? YES NO <br /> (d) Iles everyone on site, Including cranetbackhoe operator, been certified <br /> to work an hazardous waste site In accordance with CCR Title 8? YES NO <br /> 2. Iles ■ "Site Health & Sorely Plan" for this Job site been submitted? YES NO <br /> 3. lies`ap�licant performing removal In the City of Tracy obtained a "Grading and Excavation Permit"? <br /> NIA�Q YES NO I I If YES, Permit it upon approval <br /> 4. flat the` contractor obtained approval from the local fire department to perform tank cutting? NA( ) YES[ I NON <br /> S. Is there knowledge or evidence of leakage from (lie lank(s) and/or piping? (if yes, please explain) YES I I NON <br /> 6. If tank reAdual exists, Identify transporting hazardous waste hauler: <br /> Name Nor Cal Waste Oil haulers Hauler Registration N CAR 982417255 <br /> Address P. 0. Box 645 City Dena i r, CA ZIP95316 <br /> Phone N ( 800 ) 332-8710 <br /> 7. Decontamination Procedure: <br /> e. Will tank(s) and piping be decontaminated prior to removal? YES P4 NO <br /> b. Identify contractor performing decontamination: <br /> Name Jim Thorpe Oil , Inc. <br /> Address P• 0. Box 357 City Lodi Zip 95241-0357 <br /> Phone No.( 209 368-6175 <br /> C. Describe inethod to be used for decontamination: <br /> Tank(s) and piping will be triple rinsed with a biodegradable soap solution <br /> d. Describe how rinsate material will be stored onsite prior to manifesting gffsite: <br /> Rinsate will hither be removed from the tank the waste oil hauler while <br /> the tank and lines are being rinsed or stored in labled and sealed drum's <br /> on s to unt they can be removed to a proper d sposal ac 1 ty. <br /> e. Rinsate hauler and permitted Treatment, Storage do Disposal Facility: <br /> Hauler Name same as #6 flouter Registration N <br /> Address City Zip <br /> Phone No. ( ) <br /> Permitted Disposal Site Americlean, Inc. 2570 Almond Dr. , Silver Springs NV 89429 <br /> 5/20 <br /> Ell 23 046 (Revised 9/11/96) Page 4 <br />